How to Qualify for Medicare Savings Programs (MSPs)

What Are Medicare Savings Programs?

Medicare Savings Programs, often called MSPs, are state-run programs that help people with limited income and resources pay certain Medicare costs. Depending on the program, an MSP may help pay your Medicare Part A and Part B premiums, deductibles, coinsurance, and copayments.

These programs are administered by each state, so eligibility rules can vary. Even if your income or resources are slightly above the federal limits, you may still qualify in your state because some states use more flexible rules.

If you qualify for certain Medicare Savings Programs, you may also automatically qualify for Extra Help, a Medicare program that helps lower prescription drug costs.

Medicare Savings Programs help eligible Medicare beneficiaries pay some or all of their Medicare costs. These programs are especially important for people who have Medicare but struggle with premiums, deductibles, coinsurance, or copayments.

There are four main Medicare Savings Programs:

Minimum Federal Eligibility Requirements for Medicare Savings Programs

The federal income and resource limits for Medicare Savings Programs usually change each year. These are the current federal limits listed by Medicare.gov:

Medicare Savings Program Income and Resource Limits

Income limits are slightly higher in Alaska and Hawaii. Some states also have rules that allow people to qualify even if their income or resources are higher than the federal limits listed above. The best way to know if you qualify is to contact your state Medicaid office and apply.

What Does Each Medicare Savings Program Cover?

Qualified Medicare Beneficiary (QMB) Program

The QMB program offers the broadest help. It can help pay your Medicare Part A premium, Part B premium, deductibles, coinsurance, and copayments for Medicare-covered services.

If you qualify for QMB, Medicare providers are generally not allowed to bill you for Medicare-covered deductibles, coinsurance, or copayments. You may still owe a small Medicaid copayment if one applies in your state.

Specified Low-Income Medicare Beneficiary (SLMB) Program

The SLMB program helps pay your Medicare Part B premium. To qualify, you must have both Medicare Part A and Part B.

Qualifying Individual (QI) Program

The QI program also helps pay your Medicare Part B premium. You must apply each year, and states approve applications on a first-come, first-served basis. Priority is usually given to people who received QI benefits the previous year.

You generally cannot qualify for QI if you qualify for other Medicaid coverage.

Qualified Disabled and Working Individual (QDWI) Program

The QDWI program helps pay the Medicare Part A premium for certain disabled individuals who are working and lost premium-free Part A because they returned to work.

What Counts as Resources?

Resources generally include things like money in checking or savings accounts, stocks, bonds, and certain investment accounts. However, not everything is counted.

Your home, one car, burial funds up to certain limits, furniture, household items, and personal belongings are commonly excluded. Because states may use different counting rules, it is important to apply even if you are unsure whether you qualify.

What Is Extra Help?

Extra Help, also known as the Low-Income Subsidy, is a Medicare program that helps people with limited income and resources pay for Medicare Part D prescription drug costs.

Extra Help can help with:

• Part D premiums.
• Part D deductibles.
• Prescription copayments.
• Prescription coinsurance.
• The Part D late enrollment penalty, if one applies.

Some people qualify for Extra Help automatically. You may automatically get Extra Help if you have full Medicaid coverage, get help from your state paying your Part B premium through a Medicare Savings Program, or receive Supplemental Security Income from Social Security.

Extra Help Income and Resource Limits

If you qualify for Extra Help, your Medicare drug plan premium and deductible may be $0. For prescriptions filled at a participating pharmacy, you may pay up to $5.10 for each generic drug and up to $12.65 for each brand-name drug. Once your total drug costs reach $2100, you pay $0 for covered drugs for the rest of the year.

How to Apply for a Medicare Savings Program

Medicare Savings Programs are run by your state. To apply:

• Contact your state Medicaid office, To get direct local assistance, the best route is to use the SHIP National Locator to find the State Health Insurance Assistance Program (SHIP) office in your area. You can also reach the SHIP National Technical Assistance Center by phone at 1-877-839-2675.

• You may also apply for Extra Help through Social Security. Medicare notes that people can apply for Extra Help and Medicare Savings Programs at the same time.

You should apply even if you are not sure you qualify. Some states have higher limits or more flexible rules than the federal guidelines shown above. Applying is the only way to know for sure.

In Summary

Medicare Savings Programs can provide meaningful help for people who have Medicare and need assistance paying premiums or other Medicare-related costs. Depending on the program, you may be able to get help with your Part B premium, Part A premium, deductibles, coinsurance, or copayments.

The four main Medicare Savings Programs are QMB, SLMB, QI, and QDWI. Each program has different eligibility rules and helps with different Medicare costs. If you qualify for QMB, SLMB, or QI, you may also automatically qualify for Extra Help, which can reduce Medicare prescription drug costs. Because each state administers its own program, you should contact your state Medicaid office to confirm eligibility and apply.

For more information: Medicare.gov: Medicare Savings Programs, Medicare.gov: Help With Drug Costs, Social Security: Apply for Extra Help With Medicare Drug Costs, Medicaid.gov: Get Help With Medicaid and CHIP